臺灣博碩士論文加值系統

研究背景和目的：頸部疼痛是牙醫師最常抱怨的肌肉骨骼症狀之一，常造成在工作與生活上的困擾。牙醫師工作時常形成的頭部前傾姿勢已被證實與這樣的頸部疼痛有關。過去研究顯示頭部前傾姿勢可以透過深層頸部屈肌的訓練來改善。然而過去的研究多以躺姿來訓練深層頸部屈肌，而非這些牙醫執業時所使用的坐姿，因此尚有改善的空間。本研究比較患有頸部疼痛的牙醫師若使用在躺姿或坐姿下的頸部深層屈肌（頸長肌）單次訓練運動，對於挺直坐姿與模擬牙醫師工作前傾坐姿時的立即效應是否不同。
研究方法：本研究招募患有頸部疼痛並且持續超過3個月以上的牙醫師作為受試者，進行兩種不同姿勢的單次訓練運動。受試者依照隨機分派順序，先後在躺姿與坐姿下透過顱頸椎屈曲動作來訓練頸長肌，每次肌肉收縮停留10秒鐘並有5秒的休息間隔，每組10下收縮、一共進行5組訓練，組間則有1分鐘的休息。所量測之主要結果為使用相機拍攝的顱頸椎角度，次要結果則以超音波影像測量頸長肌之截面積、前後徑和內外徑，以比較訓練前後的立即差異，以及不同訓練姿勢間對於頭頸部位置和頸長肌活化影響的大小。
結果：共17位男性受試者（年齡31.82 ± 6.42歲）完成訓練與測試。顱頸椎角度與肌肉超音波影像測量值的施測者內信度至少有中等以上（ICC＞0.5）。主要與次要的結果經Shapiro-Wilk檢定後均為常態分佈。比較訓練效果前，先針對不同訓練順序是否有殘留效應進行檢測，在雙因子重複測試變異數分析（two-way repeated ANOVA）中發現前傾坐姿下會受到訓練順序的影響，因此只採用第一次訓練姿勢的結果作為後續比較（先躺姿8人；先坐姿9人）。使用配對t檢定（paired-t test）分析挺直坐姿時訓練前後的差異，並且利用獨立t檢定（independent-t test）比較不同訓練姿勢的影響。發現顱頸椎角度、頸長肌截面積和前後徑不管透過躺姿或坐姿訓練後，在挺直與前傾坐姿下皆有顯著進步（p＜0.05），而頸長肌截面積與前後徑增加代表訓練後頸長肌活化增加。在挺直坐姿下的頸長肌內外徑僅有坐姿訓練組的對側在訓練後有明顯減少（p＜0.05）。前傾坐姿下則只有透過躺姿訓練後有明顯下降（p＜0.05）。比較不同的訓練姿勢，挺直與前傾坐姿下顱頸椎角度與頸長肌的改變量，姿勢間沒有顯著差異，代表不同訓練姿勢對於兩種坐姿下頭部前傾姿勢與頸長肌活化的立即影響效果相同。
結論：經由躺姿或坐姿下訓練頸長肌可明顯改善顱頸椎角度，超音波測量並發現頸長肌的截面積與前後徑增加，代表透過此訓練可活化頸長肌且立即改善頭部前傾姿勢。此外，兩種不同訓練姿勢的成效並沒有差異，因此臨床使用上為求時間與空間的便利性，牙醫師可以利用執業空檔採取坐姿訓練深層頸部屈肌以減少頭部前傾姿勢與其相關造成頸部疼痛的風險。

Background and Objectives: Neck pain is one of the most common symptoms complained by the dentists, which often affects quality of work and life. Forward head posture (FHP) adopted by dentists at work has been proved to be associated with neck pain. According to previous studies, training the deep neck flexor muscle could improve the FHP. However, the training positions used in those studies were mostly supine lying, which is different from the sitting position used during dentists at work, so there is still room for improvements. This study aimed to compare the immediate effects on FHP after training of the deep neck flexor muscle (longus colli) in supine lying and sitting positions, on a group of dentists with chronic neck pain. The effects were examined in both erected-sitting posture and trunk-lean-forward posture to simulate working posture of dentists.
Methods: Dentists who had chronic neck pain lasted at least three months were recruited in this study. All subjects received training of the longus colli in two positions, supine lying and sitting, in random order with sufficient rest in between. There are total 5 sets with 1-minute break between in one session longus colli muscle training. In each set, subjects made their muscle contraction for 10 seconds and repeated 10 times with 5-second rest between. Craniocervical angle (CV angle) took by the digital camera was used as main outcome measurement. Ultrasonographic measurements of bilateral longus colli muscles, cross-section area (CSA), anterio-posterior dimension (APD), and lateral dimension (LD) were the secondary outcome. The CV angles and sonography measurement were compared before and after each training position, and the amount of changes was compared between the two training positions, as well as in erected and lean-forward sitting postures.
Results: Seventeen male subjects (age 31.82 ± 6.42 years old) completed the training and assessment. The intra-rater reliability of CV angle and ultrasound was at least at moderate level (ICC value＞0.5). The results of main and secondary outcomes tested by Shapiro-Wilk test shown the data were normally distributed. Two-way repeated ANOVA was used to clarify if there was any retention caused by the order of training position, and found lean-forward-sitting posture would carry the training effect of previous position. Therefor for the following examination only the training in the first position (8 in first supine and 9 in first sitting position) would be used. Paired t test was used to analyzed the change before and after each training position, and unpaired t test for the amount of changes between two training positions. In both supine and sitting training, there were significant improvements in CV angle, CSA and APD of longus colli muscle measured in both erected sitting and lean-forward sitting after longus colli training in both training positions (p＜0.05). Increased CSA and ADP of the longus colli in erected-sitting and lean-forward-sitting postures may indicate an increased activation of longus colli muscle after the training. The LD of longus colli muscle in erected-sitting posture only significantly decreased in opposite side after sitting training. Improvement in the lean-forward-sitting posture could only be seen after supine training (p<0.05). There was no difference in the amount of change for CV angles, CSA, APD and LD between two different training positions in both erected-sitting and lean-forward-sitting postures. That means the immediate effects on forward head posture and activation of longus colli muscle in these two training positions were the same.
Conclusion: Training of longus colli muscle in supine lying or sitting position can significantly improve CV angle and increase CSA and APD of longus colli muscle. The changes mean that increased activation of longus colli muscle after training could immediately improve FHP. Effect of training in sitting position is just as good as in supine lying position. Hence, in clinical situation, dentists can practice the muscle training protocol in sitting position whenever is convenient during their working hours to avoid FHP and risk of neck pain.

致謝辭 i
論文中文摘要 ii
論文英文摘要 iv
目 次 vii
圖目錄 ix
表目錄 x
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 4
第三節 研究假說 5
第二章 文獻回顧 7
第一節 頭頸部姿勢與頸部疼痛 7
第二節 頸部疼痛與肌肉的變化 8
第三節 運動介入的成效 11
第三章 研究方法 20
第一節 研究設計 20
第二節 研究對象 20
第三節 結果測量與評估工具 21
第四節 研究流程 22
第五節 統計分析 24
第四章 研究結果 34
第一節 受試者基本資料 34
第二節 操作者的再測信度 34
第三節 訓練順序的殘留效應（retention effect） 34
第四節 頸長肌訓練後對於挺直坐姿的立即反應 35
第五節 頸長肌訓練後對於前傾坐姿的立即反應 36
第五章 討論 50
第一節 研究發現 50
第二節 頸長肌訓練 51
第三節 頭部前傾姿勢的反應 52
第四節 頸長肌的變化 53
第五節 不同訓練姿勢的比較 55
第六章 研究限制與未來方向 58
第七章 結論 60
參考文獻 61
附錄一 人體試驗/ 研究同意證明書 67
附錄二 中文版頸部失能指數 68
(Taiwan version of Neck Disability Index) 68

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